How to Talk About Dying

Dr. Smith suggests a “hope for the best and plan for the worst” approach.

Because physicians are not as forthright as they should be with patients about their prognoses, many terminal patients mistakenly believe their illnesses to be treatable. In an interview on CBS This Morning, Dr. Thomas Smith of Johns Hopkins University advocated for greater discussion about end-of-life issues between physicians and their patients. A palliative care consultant for the International Palliative Care Initiative of the Open Society Foundations and former faculty scholar with the Foundations’ Project on Death in America, Smith highlighted an article he published this week in the New England Journal of Medicine entitled “Prescriptions for Palliative Care.”

Smith’s article offers strategies that can improve this communication, including the integration of palliative care in end of life discussions. Yet he rightly recognizes that hope at the end of life cannot be extinguished, nor should doctors stand in the way of that hope. He prefers a “hope for the best and plan for the worst” approach.

The International Palliative Care Initiative has long recognized this need. It has advocated for the integration of palliative care into health systems globally, and been a leader in the education of health care professionals around these topics. We welcome Dr. Smith’s insights into how best to undertake the difficult conversations needed around dying. IPCI works to improve quality of life for patients with life-limiting illness across the trajectory of disease.